Feasibility, Efficacy, and Safety of Percutaneous Muscle Biopsies in Patients With Chronic Liver Disease.

Jonathan I Quinlan,Felicity Williams,Amritpal Dhaliwal,Carolyn A Greig,Matthew J Armstrong,Sophie L Allen,Janet M Lord,Leigh Breen,Ahmed M Elsharkawy

doi:10.3389/fphys.2021.817152

Abstract

IntroductionSarcopenia is present in many chronic disease states including decompensated end stage liver disease (ESLD) and non-cirrhotic non-alcoholic fatty liver disease (NAFLD). Sarcopenia in ESLD can negatively impact quality of life and increase mortality. Despite this, very little is understood about the mechanisms of sarcopenia in these conditions. One key reason for this is the reluctance to undertake percutaneous muscle biopsies due to the perceived increased risks. ESLD can induce thrombocytopaenia and coagulopathy which significantly increases the risk of bleeding. In addition, patients with either NAFLD or ESLD often have co-morbidities that would require additional care and risk assessment. Thus, the aim of this study was to establish an effective and safe protocol for the implementation of percutaneous muscle biopsies in patients with NAFLD and ESLD.MethodsA total of 47 patients with ESLD and 9 patients with non-cirrhotic NAFLD were recruited from the Liver Unit, Queen Elizabeth Hospital (Birmingham, United Kingdom). A total of 71 percutaneous vastus lateralis biopsies were attempted over two study visits. A vigorous safety screening occurred prior to and during each visit and a strict protocol was followed to mitigate against complications and risk.ResultsA total of 85% of patients consented to the muscle biopsy at either visit (48/56). A total of 9% of consented biopsies could not occur due to medical considerations, including high international normalised ratio (INR) (n = 3) and the use of aspirin (n = 4). Muscle tissue was obtained from 90% of attempts, with a mean average yield (wet weight tissue) of 98.1 ± 52.9 mg.ConclusionPercutaneous muscle biopsies are both feasible and yield sufficient tissue in an ESLD population. The procedure is effective for obtaining muscle tissue whilst also safe, with only one adverse event. This study provides evidence for the successful use of muscle biopsies in this population, even in consideration of disease specific complications, medications, and comorbidities.

Highlights

Sarcopenia is present in many chronic disease states including decompensated end stage liver disease (ESLD) and non-cirrhotic non-alcoholic fatty liver disease (NAFLD)
Secondary sarcopenia is often present in chronic disease states such as chronic liver disease (CLD); non-alcoholic fatty liver disease (NAFLD) and end stage liver disease (ESLD)
In the visits that did occur, 85% of patients agreed to undergo a muscle biopsy (48/56), with only 13 biopsies not occurring due to patients declining

Summary

Introduction

Sarcopenia is present in many chronic disease states including decompensated end stage liver disease (ESLD) and non-cirrhotic non-alcoholic fatty liver disease (NAFLD). Sarcopenia in ESLD can negatively impact quality of life and increase mortality. Secondary sarcopenia is often present in chronic disease states such as chronic liver disease (CLD); non-alcoholic fatty liver disease (NAFLD) and end stage liver disease (ESLD). Sarcopenia is reported to be present in approximately 25–70% of ESLD patients (Kim et al, 2017) and negatively impacts quality of life, significantly increases mortality risk, and may adversely affect the outcome of liver transplantation (Carey et al, 2017). Despite these implications, the underlying mechanisms of sarcopenia within CLD remain relatively unknown

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